Passing under the bicipital aponeurosis, the brachial artery divides into the radial and ulnar arteries. Radial forearm free flap musculoskeletal system medicine. Tissue defect reconstruction using radial forearm free flap rfff is a common surgical technique whose success or failure is mainly. The radial forearm flap has been widely used in reconstructive surgery of head and neck regions. The radial forearm free flap was inset in the scalp over a drain using interrupted sutures e. A subcutaneous tunnel was created to access the temporal vessels c.
We have used the radial forearm free flap for soft palate reconstruction in 15 patients treated for cancer of the oropharynx during the past 42 months. The free radial forearm flap frff has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. Previous attempts to use an osteocutaneous radial forearm free flap ocrfff for head and neck reconstruction have been associated with unacceptable donor site morbidity, most commonly fracture of the radius. From 2005 to 2012, 20 radial forearm flaps were used to repair the defects.
The flap can be made sensate by inclusion of either the medial or lateral cutaneous nerves of the forearm. The radial forearm flap journal of plastic, reconstructive. Longterm functional donor site morbidity of the free radial. Radial forearm free flap fasciocutaneous hns preferences.
It has since become a workhorse for soft tissue replacement in head. Chinese flap, is a free flap technique that was developed by dr yang goufan, dr chen baoqui and dr gao yuzhi of. The radial forearm fasciocutaneous free flap for head and. Pdf free radial forearm flap and anterolateral thigh.
Material and methods the clinicopathologic data of 46 tongue carcinoma cases hospitalized from december 2009 to april 2014 were obtained from. Radial forearm versus anterolateral thigh fl ap reconstruction after hemiglossectomy. Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity. Osteocutaneous radial forearm flap free tissue transfer. It is the most commonly used free flap for reconstruction in the head and neck. Radial forearm free flap is the most reliable flap for intraoral soft tissue reconstruction after cancer ablation surgery. My main question is how long did it take for the free flap swelling to go down in order to completely close your mouth therefore increasing the ability to eat. The harvested radial forearm free flap measured 6 x 12 cm d. Haemodynamic changes in the fingers after free radial. Radial forearm free flap what is a radial forearm free flap. We report the first use in the uk of an osteocutaneous radial forearm free flap in the reconstruction of a subtotal nasal deficit. Left designing and right harvesting left radial forearm free. Background to compare free thin anterolateral thigh alt flap with free radial forearm frf flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin alt flap.
The interest of this flap resides in the preservation. Use of amniotic membrane for radial forearm free flap. He then does a skin graft on the donor site for closure. The radial forearm flap based on distal perforators of the radial artery is a recent flap, derived from the socalled chineseflap. Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Flap choice should be dictated by the needs of the patient and those of the site to be reconstructed. Department of plastic, reconstructive, aesthetic and hand surgery, university hospital of basel, basel, switzerland. The radial forearm flap has also been used as fascial rather than fasciocutaneous flap12,18,19,20. Outcomes of the osteocutaneous radial forearm free flap for. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. Radial forearm free flap free download as powerpoint presentation. Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects. Several types of free flaps can be used to restore defects within the oral cavity and orohypopharynx anterolateral thigh flap, rectus abdominis musculocutaneous flap, free deltoid flap, etc.
This piece of writing comprised all the detail about harvesting radial forearm free flap, advantages, disadvantages. Tongue reconstruction with free radial forearm flap after. Complications of free radial forearm flap transfers for head. Your hospital stay after radial forearm free flap surgery. Page 2 of 5 your hospital stay after radial forearm free flap surgery uwmc otolaryngology head and neck surgery center box 356161 1959 n. Free flaps did not, however, become widely used for hypopharyngeal reconstruction until after the refinement of microvascular techniques during the 1970s. It must be a unicortical block of volar radius, and no wider than 1. To evaluate the clinical, functional and aesthetic outcomes for radial forearm free flap rfff donor sites covered with amniotic membrane am. In 1978, a fasciocutaneous free flap from the volar aspect of the forearm and pedicled on the radial artery was first used in china.
This study presents the keystone local flap surgical technique and the outcomes of the rfff donor site closure with both techniques. Reconstruction of the buccal mucosa following release for submucous fi brosis using two radial forearm fl aps from a single donor site. Negative pressure wound dressings npd may increase blood flow and perfusion as compared to static pressure dressings spd designed to minimize. The ulnar forearm flap has the advantages of thin and pliable skin, constant and large pedicle, and the teclinical possibility of combination with the muscles, sensory or motor nerve, and ulna. Radial forearm free flap postoperative instructions 2 tube or tracheostomy and will be on a ventilator. Partial necrosis may occur at the distalmost dorsoradial part of the flap as a result of. The forearm flap is a fasciocutaneous flap based on the fasciocutaneous perforators from the radial artery. Less commonly,lateral upper arm free flap, pectoralis major flap and a combined brachiaradialis radial forearm flap. In 23% of cases one of the blood vessels supplying or draining the flap can develop a blood clot.
Address correspondence to dr maciejewski, department of oncologic surgery, centre of oncology, wybrzez. The radial forearm fasciocutaneous free flap rfff has been used both as a patched graft in cases in which there is insufficient mucosa to achieve primary closure, as well as a tubed flap for reconstruction of circumferential defects of the hypopharynx and cervical. Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. This means that the flap doesnt get any fresh blood or, if. Median nerve injury following radial forearm free flap harvest. Since its first description in 1981, the radial forearm free flap has become a valuable tool for reconstructive microsurgery. The radial forearm free flap was first harvested by dr. The radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Jun 04, 2016 the radial forearm fasciocutaneous flap was first described by yang and colleagues in the chinese literature in 1981 and was coined the chinese flap. Jan 30, 20 the ideal method for buccal defects should provide good outcome of both function and appearance.
Second free radial forearm flap for urethral reconstruction after partial flap necrosis of tube. Radial forearm flap was a reliable method for throughandthrough buccal reconstruction with high success rate and good functional result. Forearm free flap phalloplasty this procedure is considered by many to produce a more realisticlooking, more erotically sensate phallus than older phalloplasty procedures. The radial artery provides nutrient inflow to the flap via perforating vessels that pierce the. Free radial artery forearm flap in reconstruction of oral. The radial forearm free flap is a viable reconstructive option for tongue defects especially where a thin, pliable flap is needed. Physiotherapy advice after radial forearm free flap surgery.
Revisiting radial forearm free flap for successful venous drainage. Some of the advantages of the fascial flaps are the reduction in the donor site deformity which can be closed directly, avoidance of hair in palmer reconstruction in hirsute individuals and reduction of the thickness of subcutaneous tissue in some. Although associated complications are inevitable in a percentage of patients, it is good. The radial forearm free fasciocutaneous flap 1 is a remarkably versatile and reliable tool in head and neck reconstruction.
Free radial forearm flap and anterolateral thigh flap for. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. The radial forearm free flap provides an excellent skin paddle, with adequate surface area and thickness. Thirteen patients achieved an oral diet, while 2 patients remained dependent on tube feeding. Clinical reliability of radial forearm free flap in repair of. Radial forearm free flap surgery is a versatile technique that is widely adopted for microvascular reconstruction of the oral, oropharyngeal and hypopharyngeal. The radial forearm free flap should not be used for every head and neck defect. It is likely that you will experience some stiffness and weakness in your arm after having this surgery.
A single patient in this group had a partial brachioradialis muscle flap raised as chimeric component to the composite radial forearm flap. Free tissue transfer is the mainstay for reconstruction of large head and neck defects for both benign and malignant disease. The purpose of this study was to report the clinical results of doublelayered collagen graft to the donor site of the forearm free. Learn about the free radial forearm flap, an online 3dvideobased course, accredited by the royal college of surgeons of england. The healing process of patients with rfff donor sites covered with am was prospectively followed for 1 year.
Four patients underwent reconstruction by composite radial forearm flaps including both the cutaneous nerve of the forearm and the palmaris longus tendon. The radial forearm flap in reconstruction of upper limb. The dominant pedicle is the radial artery, with venous outflow through the dual system of the venae comitantes and cephalic vein. The free radial forearm frfa flap is universally still considered as the gold standard technique in penile reconstruction. Download as an information leaflet pdf radial forearm flap. Ab the unique attributes of the radial forearm flap for head and neck reconstruction make it a primary choice from the reconstructive ladder. Typically, a considerably large flap is required, often involving almost the entire circumference of the forearm. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Yang and gao of the shenyang military hospital initially introduced the radial forearm flap, often called the chinese flap.
A rare case of a normal preoperative arteriogram and acute intraoperative hand ischemia. The radial forearm free flap rfff as a fasciocutaneous flap was developed in 1978 in the peoples republic of china but it was soutar and colleagues in 1983 from scotland who popularized the. Radial forearm flap british association of oral and. The osteocutaneous radial forearm free flap ocrfff was described in 1978, 4 but its widespread use was limited due to early reports of significant donor site morbidity. Pdf folded free radial forearm flap for reconstruction. Donor site morbidity following radial forearm free flap. Radial forearm versus the ulnar forearm free flap full text. Additionally at the 12month evaluation, objective scoring systems were used to assess the aesthetic vancouver scar scale, vss. Doublelayered collagen graft to the radial forearm free. Double bilobed radial forearm free flap for anterior tongue and floorofmouth reconstruction. Radial forearm free flap for soft palate reconstruction. However, unesthetic scar of the donor site and the need for a second donor site for skin graft are major disadvantages of the forearm flap. Since 1992, we have carried out 38 frff transfers in 37 patients for reconstruction after head and neck cancer ablative surgery.
A radial forearm free flap is one way of filling a hole which is left when a cancer has been removed. The number of perforators is greatest between 12 and 20 cm from the takeoff of the radial artery, and these are the vessels captured in the distally located skin paddle. Pdf salvage of free radial artery forearm flap following. In the cpt for skindeep tissue flaps 15xxx, it states a repair of a donor site required a skin graft or local flaps is. Radial forearm free flap is regularly used in reconstruction of oral and maxillofacial region after ablative cancer surgeries. Pdf described in 1981 by the chinese authors yang kuofan et al. Free radial artery forearm flap in reconstruction of oral cavity cancers our experience 88 int j res med. This flap,however,is only suitable for small tumours of the tongue and offers very little to the more common situations where wider resections are required. There is acceptable form and functional restoration with minimal donor site morbidity. A fullthickness paramedian forehead flap supplied external coverage.
The radial forearm free flap and the ulnar forearm free flap are both welldescribed procedures used for free tissue transfer in reconstructive surgery. The microsurgery is usually easy to perform due to large vessels and a long pedicle. When this socalled chinese flap was originally described by yang et al. The skin of the radial forearm free flap was tubed to recreate the nasal lining and the radial bone reconstructed the dorsal contour of the nose. A spectrum of functional donorsite deficits following harvest of this flap is reported. Tracheal reconstruction with the use of radial forearm. Functional reconstruction of subtotal glossectomy defects. Optimizing hand and wrist function in the postoperative period may allow more efficient selfcare and return to activities of daily living.
Folded free radial forearm flap for reconstruction of fullthickness defects of the cheek. Doublelayered collagen graft to the radial forearm free flap. Oct 17, 2014 the flap can be tubed or folded for pharyngeal and soft palate reconstruction, respectively. With the introduction of the radial forearm flap by song, plastic surgeons were quick to realize its potential in head and neck reconstruction. Free bipedicled radial forearm and posterior interosseous. Radial forearm free flap pharyngoesophageal reconstruction.
This is surgery that removes a piece of skin from your inner forearm and uses it to replace tissue that was removed due to cancer. Jan 22, 2016 the fasciocutaneous radial forearm free flap fcrfff is the most common free flap used in head and neck reconstruction. The radial forearm flap is usually used in reconstruction of the mutilated hand as a reverse pedicled flap, but occasionally, a free radial forearm flap can be harvested from the contralateral forearm. These include no deficit, to wrist stiffness with loss of range of motion, diminished strength of the hand and wrist, dysesthesias, hand or wrist swelling, pain, and healing problems. Understand the relevant anatomy associated with this procedure.
Surgical technique ottie van zyl the radial free forearm flap rfff was one of the first free tissue transfer flaps to be described. Mandibular reconstruction using osteocutaneous radial. Osteocutaneous radial forearm free flap harvest and plating. Harii described the use of a tubed fasciocutaneous free flap for pharyngoesophageal reconstruction in 1985. Advancing education, research, and quality of care for the head and neck oncology patient. Cadaveric studies performed in 1978 identified this flap and subsequent clinical series published in the chinese literature in 1981 sealed it as a viable reconstructive option. It is one of the most common ways of replacing tissue in the head and neck, particularly after mouth cancers have been removed. When your condition is stable and there is a room available, you will move to. Doctors often use this surgery to reconstruct an area in the head and neck. Assessment of donorsite functional morbidity from radial. Pdf folded free radial forearm flap for reconstruction of. Radial free forearm flap rfff surgical technique vula.
It is most often designed as a free flap but may be pedicled e. Perhaps one of the most versatile free flaps that exists for head and neck reconstruction is the radial forearm fasciocutaneous flap, which allows for a thin, pliable piece of tissue to be transferred on a long vascular pedicle with a reliable blood supply. Comparing it with the radial forearm flap, there is no possibility of exposure of flexor tendons, which usually results in the good take of skin grafts. Jun 04, 2016 the radial forearm flap is a reliable, versatile flap, based on the radial artery, that can be applied to reconstruction of many anatomic structures in the head and neck.
This is due to the nature of the skin of the forearm areas on the underside of the forearm are of good consistency and often are fairly hairless as well as the nerves and. We analyzed the superiority and reliability of the flap. Traditionally, the fibula free flap has been the mainstay for mandibular reconstruction, with its increased length and quality of bone stock. Radial forearm flap an overview sciencedirect topics. Free radial forearm flap and anterolateral thigh flap for reconstruction of hemiglossectomy defects. A new bilobed design for the sensate radial forearm flap to preserve tongue mobility following significant glossectomy 2004. Comparison of radial forearm with fibula and scapula. The radial forearm flap is supplied by the radial artery and perforators from the radial artery to the overlying skin. Oct 29, 20 outline radial forearm flaps lateral arm flaps lateral thigh flap anterolateral thigh flap rectus abdominis flaps latissimus dorsi flap gracilis flap temperoparietal fascial flap fibular osteocutanous flap iliac crest flaps scapular flaps metatarsal flap rib flaps jejunum omentum gastroomentum. Cpt 20969 radial forearm free flap medical billing and. Free tissue transfer is a mainstay in head and neck reconstruction following surgical oncologic tumor resection.
I was in icu for 12 days due to an infection in my neck. It has since become a work horse for soft tissue replacement in. Donor site complications secondary to radial forearm free flap rfff reconstruction can limit recovery. It is as hardy as the latissimus dorsi flap in withstanding postoperative adjuvant radiation, and confers multiple advantages over the latissimus dorsi free flap including faster healing times and shorter hospital stays. A, postoperative appearance 5 years after a radial forearm free flap donor site.
The increasing success rate of free flaps along with their reconstructive advantages have got them into regular practice options in maxillofacial reconstruction. Although forearm free flaps are frequently performed, there is insufficient prospective data looking at the morbidity of the radial compared to ulnar forearm free flaps. I had 50% of my tongue removed and replaced with a radial forearm flap. Radial forearm free flap rfff is a versatile reconstructive method, first described by yang et al. You may be sent home with a clear dressing over the radial forearm incision or the thigh skin graft site, the clear dressing will come off on its own. It later became popularized as the workhorse for head and neck reconstruction by soutar and coworkers in the 1980s because of its reliability and flexibility in design. Osteocutaneous radial forearm free flap in subtotal nasal. Radial forearm free flap iowa head and neck protocols. The flap is based on the axis of the radial artery. Less commonly,lateral upper arm free flap, pectoralis major flap and a combined brachiaradialis radial forearm flap can be used instead of the frff. Physiotherapy is important, as it can help you regain full function of your arm and return to your daily activities. Reconstruction of scalp defects with the radial forearm free flap. Therefore, free fascial flaps, such as temporoparietal flaps, 2 serratus anterior fascial flaps, 3, 4 and radial forearm fascial flaps, 5 are useful options for reconstruction because of their thinness and pliability.
263 518 392 735 17 394 1618 120 884 449 1371 1440 1664 200 758 315 221 797 1684 7 358 1505 117 1665 333 89 1449 407 442 551 257 582 1625 1191 1622 321 886 426 979 1282 1480 147 113